Impact of induction immunosuppression on patient survival in heart transplant recipients treated with tacrolimus and mycophenolic acid in the current allocation era.
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BACKGROUND: The practice of induction therapy with either rabbit anti-thymocyte globulin (r-ATG) or interleukin-2 receptor antagonists (IL-2RA) is common among heart transplant recipients. However, its benefits in the setting of contemporary maintenance immunosuppression with tacrolimus/mycophenolic acid (TAC/MPA) are unknown. METHODS: We compared post-transplant mortality among three induction therapy strategies (r-ATG vs IL2-RA vs no induction) in a retrospective cohort analysis of heart transplant recipients maintained on TAC/MPA in the Organ Procurement Transplant Network (OPTN) database between the years 2006 and 2015. We used a multivariable model adjusting for clinically important co-morbidities, and a propensity score analysis using the inverse probability weighted (IPW) method in the final analysis. RESULTS: In multivariable IPW analysis, r-ATG (HR=1.23; 95% CI=1.05-1.46, P=0.01) remained significantly associated with a higher mortality. There was a trend toward having a higher mortality in the IL2-RA (HR=1.11; 95% CI=1.00-1.24, P=0.06) group. Subgroup analyses failed to show a patient survival benefit in using either r-ATG or IL2-RA among any of the subgroups analyzed. CONCLUSION: In this contemporary cohort of heart transplant recipients receiving TAC/MPA, neither r-ATG nor IL2-RA were associated with a survival benefit. On the contrary, adjusted analyses showed a significantly higher mortality in the r-ATG group and a trend toward higher mortality in the IL2-RA group. While caution is needed in interpreting treatment effects in an observational cohort, these data call into question the benefit of induction therapy as a common practice and highlight the need for more studies.
Amin, A. A., Araj, F. G., Ariyamuthu, V. K., Drazner, M. H., Ayvaci, M., Mammen, P., ... Tanriover, B.
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Amin, Alpesh A||Araj, Faris G||Ariyamuthu, Venkatesh K||Drazner, Mark H||Ayvaci, Mehmet US||Mammen, Pradeep PA||Mete, Mutlu||Urey, Marcus A||Tanriover, Bekir
